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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�• ! Siate Form 43709 (RS / 4-03) � �
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� Prescnbed by Department of Local Govemment Finance
INSTRUCTIONS: APR `L 6 ZOO6
File Mark
To be filed in person or by mail with the County Auditor of the county whe2 the property is located. `�
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year fhe deduction is f6bael�CNVB�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0% the y����1(�e��t' n is to 6e ehective.
GIBSON COUtv i ,
See reverse side /or additional instructions and qualifications.
(owner
Taxing
Assessed vatue of real property as of
March 1, current year
no, what is his / her exact share of interesl?
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reverse side)
Key number / legal description
, Rewrd n ber /n C
V J
oao� - oo�l i�� ' o� �
Mortgage / Contrad indebtedness unpaid as
March 1, current year .
If name on record is diHerent than that of applicanl, indicate below:
'me of moRgagee or contract selier �:
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Address of mortgagee or conlrad seller (number and st�eet, city,
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand st�eet, city, state, ZIP code)
Does appiicant own property in any other If yes, what county?
county in Indiana?
Deduction
zo
If owned with
ZIP
Page number
Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
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other than spouse, indicate with whom.
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Is the property in question:
❑ Real Property ❑ Mobile Home (IC fr1.1
What Taxing District?
/ COUNTY AUDITOR
in tne amouni of:
20 ��_ 20 � 20 20
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County Auditor
Has this deduction been requested on
property for current year? �] Yes ❑ No
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certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
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y
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person
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